posted
Yeah, when I was a medstudent in the ER needing antibiotics I told them not to do a pregnancy test. I lied and stated my period was a week earlier. But I wasn't sexually active, so I didn't need the test. They nodded and agreed not to but later I looked. Yes, they DID do it. By blood test. I've seen so many pregnant people in denial since then that I'm not angry anymore. They shouldn't have lied to me though.
Posts: 1014 | Registered: Jul 2005
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quote:Quick question--if a woman has an epidural and it is working well, will they forego the general anesthesia in rush c-sections?
Is that one of the reasons why OBs tend to favor epidurals?
To the first question, I believe the answer would generally be "yes," but I'm not an OB/Gyn, so it's just an educated guess. What you need is to be able to cut and sew back up, and any sort of anesthesia that allows you to do that (relaxed muscles and pain control) should suffice.
As to whether that is why they tend to prefer epidurals, I have no idea. Could be plenty of things that factor into that. (Honest answer -- culture and comfort level could be big factors, too.)
Posts: 14017 | Registered: May 2000
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I imagine it greatly depends on how the epidural works on that person--a very difficult thing to ascertain from the outside.
I have had two epidurals, and both knocked out all sensation of all kinds from the waist down, and probably higher than that. They could have cut off my leg, and I wouldn't have known it if my eyes were averted. My leg fell off the table, and I had to ask, "Which one?"
I think a lot of women have epidurals for c-sections also--it seems like a lot of women are awake for them (though these are planned c-sections a lot of the time--I think.)
If epidurals do prepare a woman for the worst of emergencies, I can understand doctors encouraging women to have them. My first OB thought any woman who wanted to go through natural childbirth voluntarily wasn't right in the head. My husband tends to agree. Posts: 7050 | Registered: Feb 2004
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When I had my son in hospital I refused to have an epidural. The nurses repeatedly said, 'but what if you need an emergency c-section?'. I know many women who have had c-sections, all of them had them awake and with epidurals. So I'd say yeah ... they would forgo general almost all the time for c-sections when you have an epidural.
However I know of women who were put under after c-section delivery to do other procedures/repairs where needed.
I'm glad to know I'm not right in the head but I know many OBs who avoid epidurals when they aren't demanded or needed as they can slow labour and cause ineffective pushing. I'd prefer a quick natural labour to a long haul with a large catheter in my back. Posts: 251 | Registered: Apr 2005
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I'm pretty sure you're "right in the head," bev. *grin
You have a good head on your shoulders. You also have strong and well-thought-out opinions, and you have a steel-spined character. That doesn't make for a very easy person to push around.
*high-fives
We need all the strong women we can get in the world.
[You, too, Miriya. And welcome to Hatrack! ]
[Edit 2: Ack! I see you've been here for quite awhile, Miriya. I'm so sorry -- I'm just slow. ]
Posts: 14017 | Registered: May 2000
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posted
At least at my hospital, they only used general anesthesia for c-sections if it was an absolute emergency. I didn't plan to have one, but ended up with a semi-emergency one anyway because my daughter was in distress. I had had an epidural put in already, and they just increased the dosage in preparation for the operation.
It was very strange, because I could sort of feel things, but not pain. When they delivered her I felt a huge amount of tugging, which the doctors had warned me about before-hand.
Luckily, they let my husband come to the OR with me and hold my hand. I'm not sure how well I would have done if he hadn't been there. Not many things scare me, but abdominal surgery is definitely one of them.
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Epidurals don't work for everyone, and they don't work perfectly for even more. For instance, I had an epidural that worked well enough to dull the pain for me to relax and have the baby, but never stopped the pain completely. (They kept pinching me to make sure I knew the difference between "pain" and "just pressure". ) So I don't think that would have been good enough for a c-section, even though it worked for labor. And doesn't it complicate things if you have an epidural and then they want to do a spinal block or need to do general for an emergency? (They had to stop upping the dosage at one point because the room started spinning for me and my speech got garbled.)
Posts: 21182 | Registered: Sep 2004
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Thanks, Sara. Of course, after my ranting is done, I start second-guessing myself and wondering if I went overboard.
Miriya, I went natural last time (by choice) and intend to do so again this time. My husband is freaked out, but he doesn't try to change my mind either. Wise man.
One of the reasons why I like my CNMs is that they are so much more oriented towards supporting me in what I want rather than getting on a soapbox and pushing their preconceived notions (my first OB). I know there are wonderful, supportive doctors out there too, but the hunt for the right doctor can be exhausting. I'm happy with what I've found. It takes energy to go against the grain, and I prefer to have less obstacles in my way.
Posts: 7050 | Registered: Feb 2004
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quote:[Edit 2: Ack! I see you've been here for quite awhile, Miriya. I'm so sorry -- I'm just slow. [Blushing] ]
CT: No worries... I haven't posted all that much outside the pregnancy thread since I've spend most of the last five months in the clutches of nausea and crankiness. (pregnant with hyperemesis... ick)
Epidurals: my understanding is that in a c-section you do feel a lot of pressure and pulling, etc but not so much the pain of being cut open, etc. It is still prefered for c-sections I believe because the medication doesn't affect the baby as adversely as general anesthesia and because that way moms are awake to see their babies immediately. I don't know what they do with women where it doesn't take... but I hope there aren't too many of them Posts: 251 | Registered: Apr 2005
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I think that is why most hospitals, if not all, insist that you have the "plug" in your hand for an IV drip (I can't remember the proper name). They can give you general anesthesia very quickly through it. A not-working epidural would probably be cause for it to be used.
Posts: 7050 | Registered: Feb 2004
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quote: One of the reasons why I like my CNMs is that they are so much more oriented towards supporting me in what I want rather than getting on a soapbox and pushing their preconceived notions (my first OB). I know there are wonderful, supportive doctors out there too, but the hunt for the right doctor can be exhausting. I'm happy with what I've found. [Smile] It takes energy to go against the grain, and I prefer to have less obstacles in my way.
I agree. "Informed Choice", as opposed to informed consent, is one of the three tenets of midwifery care in Ontario. That makes it pretty standard to expect midwives will take your preferences and choices seriously so long as they aren't seriously unsafe. It's hit or miss with OBs although there are wonderful ones!
By the way, I really hope I don't come across as one of those "natural childbirth is the only way" people. I find that attitude quite distasteful. A successful childbirth is one with a healthy outcome for mom and baby. Whatever works for you. Good luck! Posts: 251 | Registered: Apr 2005
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I had a dream last night (well, really, this morning) that I was pregnant, with twins, and didn't know it because I had gotten my period every month anyway and we always use condoms. I went to the ER with severe back pain and cramps and they rushed me to L & D. And my mom had to take off work to watch my other child and then I had to have an emergency c-section and one of the babies was born with Down Syndrome. And then everyone kept trying to get me to give the baby with Down Syndrome up for adoption because I wasn't capable of handling it and two other children under two. And I didn't want to because it was my baby but they were trying to make me.
I guess all my worries kind of morphed together and mixed with this thread. But it was a scary dream.
Posts: 21182 | Registered: Sep 2004
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I needed an x-ray once after my hysterectomy and the tech asked me if I was pregnant. I said no, I've had a hysterectomy. She said "Are you sure?"
Um...yeah, I'm pretty sure I've had a hysterectomy. Posts: 14428 | Registered: Aug 2001
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They used to ask me over and over if I was pregnant before my dental x-rays. Like I was going to change my mind if they asked three times. I finally told them, "I'm not sexually active. Are you happy? Now please stop asking me!" I was 14! Sheesh!
Posts: 21182 | Registered: Sep 2004
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quote:By the way, I really hope I don't come across as one of those "natural childbirth is the only way" people.
Not at all! Just letting you know a bit about where I was coming from after my "not right in the head" comments. Posts: 7050 | Registered: Feb 2004
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CT, Theca - what's with shaving before a surgery? Is it just for the ease for the surgeon, or is there really that much higher risk of infection if you don't shave the area?
Because I remember a family friend who had a terrible accident, she was just 11 years old, and needed a plastic surgeon to sew up the head wound. He left all her hair, only clipping and shaving the barest minimum of skin, so that once it was done you couldn't even tell she'd had surgery, everything was covered by her hair. I remember thinking that when she came out of surgery she'd be practically shaved bald on one side of her head, but instead, she came out with pretty much all her long hair intact.
That made me think, if he could do that, how necessary is shaving in every other case?
Posts: 14428 | Registered: Aug 2001
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posted
I've done it both ways...my son was natural, my daughter with an epidural. I liked my son's birth much better. Much. He came in 7 hours. She took twice as long. Truthfully, by comparison, his birth didn't hurt nearly as much.
But they were very different experiences from start to finish, and I wouldn't have been without that epidural for the world. It made it bearable.
Posts: 5948 | Registered: Jun 2001
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posted
Belle, my understanding is that the research shows that shaving actually increases the risk of infection. Where I trained, the women were not routinely shaved for childbirth.
This is a fairly recent change, though. When I had my first open-heart surgery in 1987, I had to shave everything except eyebrows and head hair -- pubic region, arms, everything. In contrast, I shaved nothing for the same surgery done 3 yrs ago.
quote:Best Pract Res Clin Obstet Gynaecol. 2005 Feb;19(1):103-15. Epub 2004 Dec 13.
Evidence-based intrapartum care. Hofmeyr GJ.
Effective Care Research Unit, East London Hospital Complex, University of the Witwatersrand/University of Fort Hare/Eastern Cape Department of Health, P Bag x9047, East London 5201, South Africa. gjh@global.co.za
Routine care in normal labour may range from supportive care at home to intensive monitoring and multiple interventions in hospital. Good evidence of effectiveness is necessary to justify interventions in the normal process of labour. Inadequate evidence is available to support perineal shaving, routine enemas, starvation in labour and excluding the choice for home births. Evidence supports continuity of care led by midwives, companionship in labour, restricting the use of episiotomy, and active management of the third stage of labour, including routine use of 10 units of oxytocin. Both benefits and risks are associated with routine amniotomy, continuous electronic fetal heart rate monitoring, epidural analgesia, and oxytocin-ergometrine to prevent postpartum haemorrhage. More evidence is needed regarding the emotional consequences of labour interventions, home births, vaginal cleansing, opioid use, the partograph, second-stage labour techniques, misoprostol for primary prevention of postpartum haemorrhage, and strategies to promote evidence-based care in labour.
posted
CT, I've never been shaved for childbirth, only for surgery. In particular, shaving the groin area for my hysterectomy was most uncomfortable.
Posts: 14428 | Registered: Aug 2001
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posted
They do need to shave at least the part of the head they're going to be cutting into on head surgeries, though. But most surgeons, especially ones who work with children, are careful to shave only what they need to for clear access and the nurses show the children (or parents) how to comb hair over the scar if they end up with one. (Most surgeons, especially the plastic surgeons who are often the ones doing cranial surgeries, also take pride in careful stitching that creates the least amount of scarring possible.) That's a fairly recent change that has occured with the last couple of generations of surgeons, but it's really become very standard. (My mom is the nurse-coordinator for craniofacial services for Kaiser Southern CA, so I hear a lot about this stuff.)
Posts: 21182 | Registered: Sep 2004
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I think medical practices change slowly. I think (think) that the evidence does not support shaving prior to surgery unless it is necessary to get a clear view (and then, only what is necessary). The scraped skin seems to pose more of an infection risk than clean hair does.
People are most comfortable how they've been trained, though, regardless of evidence-based guidelines. The best predictor of how a physician will treat back pain is when he or she graduated -- many older docs still recommend rest, even though moderate activity seems to help in controlled clinical trials.
It's good that things change slowly, in some ways, though. You definitely don't want fads and bandwagons to be too popular in medicine. There has to be a happy medium, even if it is hard to hit.
Posts: 14017 | Registered: May 2000
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One good thing is that if you have a good doctor who is willing to discuss things, you can bring in these studies and bring up your concerns.
Of course, my last OB graduated from med school in 1956 and he is one of the most progressive and accommodating OBs in Dallas. I guess he's just what you'd call "open-minded" (and keeps up with his CE.) He was just a sweetheart all around. I'd recommend him to anyone having a baby in Dallas.
Posts: 21182 | Registered: Sep 2004
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quote:Originally posted by ketchupqueen: Epidurals don't work for everyone, and they don't work perfectly for even more. For instance, I had an epidural that worked well enough to dull the pain for me to relax and have the baby, but never stopped the pain completely.
That's how they work on me, too. Apparently I am one of the percentage of women (I once heard an estimate of 10-20%) whose brains interpret pressure as pain.
Makes going to the dentist (as I did today) extra fun too. Posts: 32919 | Registered: Mar 2003
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but I know many OBs who avoid epidurals when they aren't demanded or needed as they can slow labour and cause ineffective pushing. I'd prefer a quick natural labour to a long haul with a large catheter in my back. ![[Wink]](wink.gif)
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) So I don't think that would have been good enough for a c-section, even though it worked for labor. And doesn't it complicate things if you have an epidural and then they want to do a spinal block or need to do general for an emergency? (They had to stop upping the dosage at one point because the room started spinning for me and my speech got garbled.)
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Apparently I am one of the percentage of women (I once heard an estimate of 10-20%) whose brains interpret pressure as pain.
